Beyond Excision: Why Your Nerves and Neuropelviology Hold the Truth About Your Pain, With Prof. Marc Possover

Send us a text with a question or thought on this episode ( We cannot replay from this link)

Professor Marc Possover reveals how our nervous system drives endometriosis pain and offers practical tools for managing symptoms through vagus nerve regulation. This groundbreaking conversation challenges traditional views of endometriosis by exploring neuropelviology – the study of pelvic nerves – and how nerve function impacts everything from pain perception to fertility.

• The pelvic nervous system controls all pelvic functions and pain signals
• Our autonomic nervous system has two branches: sympathetic (fight-or-flight) and parasympathetic (rest-and-digest)
• Endometriosis activates the sympathetic nervous system, creating widespread effects beyond the pelvis
• Vagus nerve stimulation can increase parasympathetic activity and decrease pain
• Simple techniques like ear stimulation, breath work, positive thinking, and physical activity can regulate the nervous system
• Symptoms often dismissed as "comorbidities" are actually part of one connected nervous system dysfunction
• Many patients with persistent pain after surgery may be experiencing nervous system sensitization rather than disease recurrence
• Future treatments may include neuromodulation techniques that decrease both pain and inflammation
• Understanding neuropelviology could reduce unnecessary surgeries and improve outcomes
• Both patients and doctors need education about the nervous system's role in endometriosis

Support the show

Website endobattery.com

Episode Transcript

Speaker 1 (00:00):
What if I told you that your nervous system has
more to do with yourendometriosis pain than you
probably think?
And what if I told you there'spractical tools in place that
can help you with your painmanagement?
Have you ever heard ofneuropelviology?
Maybe you've even heard aboutfight or flight, or rest and
digest and the vagus nerve.
Professor Mark Possover isjoining me today to go over that

(00:22):
and so much more.
So stick around.
Welcome to EndoBattery, where Ishare my journey with
endometriosis and chronicillness, while learning and
growing along the way.
This podcast is not asubstitute for medical advice,
but a supportive space toprovide community and valuable
information so you never have toface this journey alone.

(00:42):
We embrace a range ofperspectives that may not always
align with our own, believingthat open dialogue helps us grow
and gain new tools.
Join me as I share stories ofstrength, resilience and hope,
from personal experiences toexpert insights.
I'm your host, alana, and thisis EndoBattery charging our
lives when endometriosis drainsus.

(01:03):
Welcome back to Endobattery.
Grab your cup of coffee or yourcup of tea and join me at the
table.
Today's guest has built hiscareer on a bold but vital
belief that suffering painshould not be a life sentence,
and for Professor Mark Possover,that belief isn't just a
philosophy, it's a mission.
As a world-renowned pioneer inneuropelviology yes, you heard

(01:27):
that right he has transformedhow we understand and treat
chronic pelvic pain, especiallywhen the source is elusive or
deemed untreatable.
His work bridges the worlds ofgynecology, neurology and
minimally invasive surgery totarget the pelvic nerve directly
, often bringing relief topatients who've been told to
simply live with it.
Professor Possover isn't justtreating symptoms.

(01:49):
He's finding the root cause,especially in cases involving
nerve entrapment, endometriosisand neuropathic pelvic pain.
His methods have given hope tocountless people who have felt
like they've run out of options.
So if you've ever wonderedwhat's really going on when no
one seems to have answers, thisepisode is for you.
Please help me in welcomingProfessor Mark Possover to the

(02:12):
table.
Thank you, professor Possover,for sitting down with me today,
and this is a complete honor forme to be able to sit in this
space with you and learn fromyou, because you are a genius
when it comes to nerves.
So thank you for taking thetime to sit down with me and
expel your knowledge to us.

Speaker 2 (02:34):
Thank you very much for the invitation.
The pleasure and the honor isfor me definitely.
I think it's not a question tobe a genius, but I spent simply
20 to 25 years of my life to tryto understand the pelvic
sympathetic and parasympathetic,the pelvic nervous system,
which is not easy.

Speaker 1 (02:52):
Yeah, it's not easy, but, man, it is so central to
what we do.
Can you explain what you do?
Who you are and why thisconversation is going to be so
important is because of whatyou've done in your career, but
also this is your passion.
Can you explain a little bitabout this?

Speaker 2 (03:14):
So, as you said, I'm Marc Possevert.
Marc is my surname.
I'm a French guy.
I'm working in Switzerland, butI'm a French guy.
I started my medical study with15 and with 22, I was a
cardiovascular surgeon.
So I have a little bit of adifferent vision of the pelvis
than gynecologists.
And you know, when I started mycareer in cardiovascular

(03:35):
surgeon surgery it was in France.
That time, when thegynecologist made a mistake in
terms of bleeding, they alwayscall the cardiovascular surgeon.
And because I was a young guyin the team in the department of
cardiovascular surgery, so mychef, my boss, always said you
have to go to the gynecologist,try to solve the situation.

(03:56):
So I learned how to managecomplication in the pelvis
before I was able to performeven a sterilization.
And then, becausecardiovascular surgery was every
day more or less the same, Iwas looking a little bit on the
left, on the right and I foundthe gynecology, or the
gynecology obstetric.
And I found, yeah, it'sfascinating the gynecology,

(04:21):
because it's not likecardiovascular surgery, you have
just to deal with health orwith vascular.
But in gynecology you have justto deal with health or with
vascular, but in gynecology youhave to deal with women, you
have to deal with life.
You have to deal with obstetricmicrosurgery, laparoscopic
surgery, oncology, everything.
And then I started my fellowshipin gynecology by moving to
Germany and from there I becomea specialist in oncology and

(04:47):
endometriosis because at thattime, for more or less 30 years,
oncology and endometriosis wereone speciality and more or less
in Germany at that time we werewhat we call in the United
States pelvic surgeon.
So I'm doing all kinds ofpelvic surgery, bladder surgery,
bowel surgery and over the year.

(05:08):
What I was missing is when wewere doing a lot of surgery, big
surgeries in the pelvis, wewould induce what we call a high
morbidity.
Morbidities that meancomplication, and I'm not
talking from complication duringthe surgery like damage of the,
the bladder of the blood vessel, but the problem at that time
30-40% of our patients were notable to empty the bladder after

(05:31):
the surgery, whether we wereperforming surgery for cancer or
for endometriosis.
And you know, in cancerpatients at that time, when you
say to a patient, okay, that isa price to be alive, more or
less a patient accepts thesituation.
But when you have to deal with ayoung woman 25, 30 years old,

(05:51):
she wants to get pregnant, she'sjust married to you, do a
surgery and then she has to usea catheter.
That is a shame and that's thereason why I was starting to
think we have to reduce thismorbidity by preserving the
organs in the pelvis which arein charge of all these different

(06:11):
functions and these organs onthe pelvic nerves.
And that's the reason why Istarted to focus my attention on
the pelvic nerves.
And for 20, 30 years weintroduced laparoscopy in the
gynecology and laparoscopy islike a microscope so you can see
the small nerve from less than2.1 mm very big of the screen.

(06:34):
And that was the start of theneuropelviology what I became
over the years.
I'm still doing endometriosisand oncology, but more than 90%
of my work now is neuropelvology, so I'm a kind of neurologist
for the diagnosis andneurosurgeon in the pelvis.

Speaker 1 (06:56):
Which is fascinating because I think a lot of times,
a lot of us think aboutendometriosis as just the
disease.
We don't think about it as itbeing a nervous system issue.
Can you walk us through why thenervous system plays such a
huge part in endometriosis andwhy this matters not only to the

(07:17):
patient but to the provider?

Speaker 2 (07:19):
Yeah, the problem endometriosis.
You know it's not, it's just acause, the cause.
As when you feel pain duringyour menstruation, it's not
because you have endometriosis,you know it's not, it's just a
cause, the cause.
As when you feel pain duringhuman's bleeding, it's not
because you have endometriosisin your brain.
You feel pain because withinthe pelvis, everywhere, but not
just in the pelvis.
There is no place in your bodywhere there are no nerves, and

(07:39):
the nerves have always twofunctions.
One function is to bringinformation to the brain, and
one of these information is pain.
But it's also information likemy bladder is full, I have to go
on the toilet or I have sexualactivity or I have some desire,
and so now I'm bringinginformation to the brain, down,
like I want to empty my bladderor nerve and bring even a

(08:03):
formation to the pelvic organ.
Now is time to get an ovulationor now is time to get a
bleeding.
So an endometriosis is just oneof the cause that can induce
damage or irritation of thenerves, but are not the only one
.
If you have another infection,if you have a myoma compressing

(08:25):
the nerve or pathology of thesame nerve themselves, the
patient will feel pain.
So in endometriosis, patientshave infertility, dysmenorrhea,
pain during intercourse, painduring main bleeding because the
nerves are involved.
Without nerves, we would nothave either pain or ovulation or

(08:49):
bleeding, because the nervescontrol everything.

Speaker 1 (08:53):
Right, and there's one nerve in particular that is
the driver of this and that'sthe vagus nerve.
Can you explain the role thatthis nerve plays in our body, in
our nervous system?
The role that this nerve playsin our body, in our nervous
system?
Because I think something thatyou brought to light was the
fact that it is kind of a driverin most all pain, not just
endometriosis.

(09:13):
It drives pain, whether we'rescratching our leg on a bush or
it's.
You know we're walking andwe're having a hard time walking
or whatever that case is.
Can you explain that a littlebit better for us and why this
matters so much?

Speaker 2 (09:28):
Maybe I have to explain a little bit the nervous
system, not just in the pelvis.
You have two kinds of nerves.
You have what we call somateticnerve, that is the nerve which
command the red muscle.
So if you want to move a leg isbecause you have an activation,

(09:48):
for example, of the somaticnerve.
And behind this somatic nerveyou have a note, another nervous
system, what we call autonomicnervous system, of vegetative
nervous system.
That is a nerve system wecannot control.
For, for example, if I'mbreathing and there's no need
for me to think about that or ifmy cardiac is working, it's

(10:12):
because I have an autonomicnerve system.
Or, for example, in the pelviccavity, the bladder.
If I want to go on the toiletand to empty my bladder, my
brain is giving the information,do it.
But then the autonomic nervesystem is doing.
It's no need for me to think.
I am already avoiding mybladder.

(10:34):
That's the reason why, supposeyou want to empty your bladder,
you go on the toilet and supposeyou have a book, so you can say
okay, I want to pee.
The brain will give youinformation, but the vegetative
nerve system will do by itself.
So there's no need for you tothink while you're empty your
bladder, you can read a book,because the autonomic nerve

(10:57):
system does that by its own.
And the vegetative nerve systemis the nerve system that the
Chinese medicine well know.
And you have two systems.
You have a bad nerve system anda good nerve system.
And the bad nerve system iswhat we call the sympathetic.
It's called sympathetic inFrench, sympathetic would mean

(11:18):
nice, but it's not a nice nervesystem.
The sympathetic nerve system isinvolved in its increase in pain
, in dysmenorrhea, if you haveheadache, if you are worried, if
you don't feel good.
That is the sympathetic nervesystem.
And on the other side you havethe parasympathetic nerve system

(11:41):
, which is called the rest anddigest nerve system.
And this parasympathetic nervesystem, which is called the rest
and digest nerve system, andthis parasympathetic nerve
system is for the well-feeling.
So if you have no pain, if youfeel good in your life, you
enjoy your life, you canproperly void your bladder, you
are properly intercourse.
And all this thing is becauseyou have the autonomic nerve

(12:03):
system, course, and all thisthing is because you have the
autonomic nerve system.
And these both nerve systemsystem are in balance.
So the parasympathetic, thegood autonomic nerve system is,
if it increase, it will decreasethe sympathetic nerve system.
So suppose you have pain.
Pain means you have anactivation of the sympathetic

(12:25):
nervous system.
You can say I will reduce thissympathetic nervous system, for
that I will take painkillers.
There is another way to say,because they are in balance.
You can reduce the sympatheticnervous system and that way the
wellness system will increase.
Or you will say it willincrease by myself, without

(12:48):
painkiller.
The parasympathetic nervesystem and the parasympathetic
nerve system, you have twosystems one in the pelvis, which
you cannot control with thebrain, and you have the second
system is the vagus nerve.
And the vagus nerve is a nervethat emerges directly from the

(13:08):
brain.
It's running in the neck,outside the spinal cord, and
goes in your abdomen and willcontrol your cardiac activity,
the lung, all the differentfunctions.
So if you are able to activatethe vagus nerve in your life,
you will be more happy.

(13:29):
It's as simple as that.

Speaker 1 (13:32):
But is that an easy thing to do, which is, I think,
for a lot of us?
We're like how do we do that?
How do we activate that vagusnerve?

Speaker 2 (13:43):
I think you have three possibilities.
One is to activate the vagusnerve passively, and one very,
very easy way is what we callthe transauricular vagus nerve
stimulation, because the vagusnerve will send branch
everywhere, some nerve fiberseverywhere in the body, and some
of these fibers reach the ear.

(14:04):
And these fibers are veryimportant because they are
directly connected to the brain,so they are tense device.
Tense device that means thatbring very nice electricity.
There is some device you bringhere on the, what we call the
conch, and then you can activatethe vagus nerve.
For example, my patientaffected by endometriosis or

(14:28):
spinal cord injury patient whoare depressive, I advise them
please, in the morning, in theevening, 10 minutes when you are
lying down in your bed, try todo a little bit stimulation of
the vagus nerve here.
And there is another way.
It's how you are.
If you're staying up in themorning and you say, oh, today

(14:49):
is a bad day, you have high riskthat it will be a bad day.
If you're coming up, staying upand you're obliged to think, oh
, today is a beautiful day, Iwill have a blue sky.
If you try to convince yourselfthat it will be a beautiful day
, you have much better chance toget a beautiful day.

(15:10):
And there is another sourcemethod to increase the vagus
nerve.
It's what we call thesubliminals.
Subliminals are audios, theyare music, where, in subliminals
, you can bring a message in ahigh frequency, so you will not
hear the message, but your brainwill hear it.

(15:33):
And in this music, which isvery peaceful, you can bring the
message.
Today it will be a nice day,you will be happy, you will have
no pain Okay, you will get yourman bleeding, but you will see
it will be much better than thelast month.
And when you do that, it's likea kind of auto-suggestion which
will increase the activity ofthe parasympathetic nerve and

(15:57):
your day will be betterInteresting?

Speaker 1 (16:00):
Is this impactful with like breath work and doing
body movement, if you can, andthings like that, because we
hear a lot about that.
How important is that toincreasing that parasympathetic
system?

Speaker 2 (16:15):
Yes, with sport activity, and for that I'm
pretty nice, located here.
I'm in Switzerland because wehave the mountain, and the
mountain is really swimming andhiking, on both methods Not to
increase the vagus nerve, ofcourse, if you're in the
mountain and you see a sea, it'sbeautiful, it will make you

(16:35):
happy.
Then you have an activation ofthe parasympathetic nerve.
But if you're swimming or ifyou're hiking, you're embracing
and when you're embracing a lotyou will induce a massage of
what we call the plexus solarand this way you will decrease
the activity of the sympatheticnerve system and that way will

(16:59):
increase the parasympatheticnerve system.
So it's true, if you are doingsport activity running, hiking,
swimming you will feel the painmuch less.
And if you're thinking about apatient or a woman who are doing
very lot of activity, sportactivity and usually much, much

(17:20):
less pain during men's bleedingthan a patient who are sitting
home and yeah, it's simple likethat it's anatomically activity
will decrease the sympatheticnerve system.
And, by the way, smoking willincrease the activity of the
sympathetic nerve system.

Speaker 1 (17:37):
Interesting.
What else increases thesympathetic system?
Stress probably, I would assume.

Speaker 2 (17:44):
Exactly In principle.
You have just the sympatheticnerve system is a fight and
flight nerve system, so you havejust to sing when you're afraid
.
So let's give an example.
Three at night we met togetheron the street.
It's dark and I want to killyou.
You will not start to smile.

(18:05):
So if you are afraid for me, youhave only one thing in mind go
away.
You will try to run.
Run means you will need bloodfor the muscle, blood for the
heart, blood for your brain,blood from the lung.
So the blood in the rest of thebody will be decreased.

(18:25):
And that's the reason why, forexample, when you are affected
by endometriosis and you haveanother activity of the
sympathetic nervous system, youare white in face.
That's the reason why yourfingers are cold.
Your body is cold, but whenyou're afraid you will start
sweating.
So when you have a patient withanother activity of the

(18:49):
sympathetic system because Iwant to kill you in the night,
or because you haveendometriosis, you will be tired
, you will be white in face, youwill be cold, you will look for
something warm, but if I giveyou the hand, I will feel that
your hand is cold but wet.

(19:10):
Now, listening about the nightwhen I try, when you have to
write in the night, it's likethe cats.
You have to open the black inyour eyes to see more light.
That means when you haveanother activity of the
sympathetic nervous system, theblack in your eyes will get open
.
It's what we call a midriasis.

(19:31):
And then simply think aboutpeople in the television.
When they have to go in thetelevision, usually they have a
glass of water.
Why?
Because when you have anotheractivity of the sympathetic
nervous system, the salivationin your mouth will decrease and
that way your lips will get dry.

(19:53):
You will start being nervous,your cardiac activity will
increase, you will start tobreathe much frequently, and all
these signs you can see when apatient is coming in your office
.
You see she's white in face,the black is dilated, she has a
middle rashes, the lips are dry,the hand is cold but wet.

(20:15):
You see under the shouldershe's sweating but she has cold.
If you see she's quite nervous,look here.
When you see increased cardiacactivity and you have the
feeling she has to breathe a lot, you know she has an
overactivity of the sympatheticnerve system.
And in the life of the woman,the cause number one, which

(20:39):
every month will increase,activate the sympathetic nervous
system is endometriosis.

Speaker 1 (20:50):
And what's interesting about this is that
it sounds so simple and yet socomplex, because it's the human
side of us mixed with the bodyside of us, like the emotion
plus the body, so combiningthose two seems impossible to
manage or impossible to likethink past sometimes for a lot

(21:11):
of us.
Why is it important that weaddress this and acknowledge
that though?
Because I'm sure you see someof the patients who have severe
endometriosis, because you do alot of nervous system stuff for
endometriosis and sciaticendometriosis and teach
neuropelviology, so you'reseeing a lot of these patients
who are very in theirsympathetic system.

(21:36):
How do we regulate this aspatients?
How do?
Why is this important tounderstand and try to manage?

Speaker 2 (21:46):
you know that maybe I would say maybe we can.
I can give you later the answerhow it is important for a
patient.
But I would like to say firsthow it's important for doctors.
Because when we are a doctorwe're sitting in front of a
patient.
We see she's quite nervous, shehas a high level of stress,

(22:07):
she's pale in face and sheexplains oh, I have pain during
my mind, bleeding Everywhere inmy body.
I have shoulder pain on theright, on the right we know it
could be endometriosis on thesciatic nerve.
No, no, no, doctor, I have painon the left, endometriosis on
the left, not very frequent.
Probably the patient has somepsychological issue and you open

(22:30):
the door and the patient startsand you know, during my
menstruation something is wrong.
My feet are getting cold and Iget pain in my fingers.
That is a point as a doctorwhere you will say, ok, ok, I am
a surgeon, an endometrialspecialist.
I know that I can findendometriosis in the pelvis, but
not in the shoes, not in thefingers, not in the left

(22:52):
shoulder.
Probably I have to send thispatient first to a psychologist.
You know, in Europe we havesome certification center in
endometriosis and it's veryimportant because in this
certification you have always togive the name of a psychologist
, and that is exactly the point.

(23:12):
As a doctor, sometimes probably, we are pushing the patient
much too fast in the corner ofthe psychology and once you
understand the sympathetic andparasympathetic nerve system,
then you will understand thatall these complaints of the
patient are part of the samedisease, and the disease is the

(23:35):
irritation of the pelvicsympathetic nerve.
And endometriosis may be one ofthe causes, but it's not the
only one.
And that is a little bit myfight.
I actually, over the last 30years, I was fighting for
awareness, increased awareness,of endometriosis, not just in

(23:55):
patients but also in doctors,and now I have the feeling we
are going a little bit too far.
When patients have pain, it'sendometriosis, that's it.
And that is too easy.
When patients have an issuewith the blood or issue with the
rectum, they can experienceexactly the same pain and to say
, okay, let's do a laparoscopyand remove some endometriosis,

(24:19):
maybe you will findendometriosis, but it's not the
proof that the endometriosis isthe main cause of the pain.
Right and now for the patient.
I think it's very important tobe aware of this sympathetic
nerve system, to know, as apatient, I'm not crazy.
It's part of my disease.

(24:41):
It's part of my pathology.
Once again, if I have pain inmy left hand during my men's
bleeding, it's not because Ihave endometriosis in my left
hand, but because I have anoveractivity of the nervous
system.
And that is exactly what Imentioned.
How many patients affected byendometriosis have pain and
headache during men's bleeding?

Speaker 1 (25:02):
Yes.

Speaker 2 (25:03):
You have not to look for an endometriosis in the
brain.
It exists, but it's so certainI never saw that in my life.
But if you have an overactivityof the sympathetic nerve system
because of an endometriosis,for example in the pelvis, in
the ovarian, that will induceheadache because of an

(25:23):
overactivity of the sympatheticnerve system and that's a
treatment is not to give youantidepressant of some
painkiller for your headache butto treat the cause of the
overactivity of the sympatheticnerve system and to remove the
endometriosis.
Or maybe another cause and oneof the main, second main cause

(25:46):
in women to have an overactivityof the sympathetic nerve system
is what we call outletobstipation syndrome.
The bowel is much too long.
And you know there is a simpletrick.
I always look at the fingers ofmy patient.
When a patient has very long,thin fingers, you can be sure
that the bowel is very long,very thin and is making kinking

(26:10):
inside the pelvis and then thepatient has a bloating bowel
with bloating abdomen, pain inthe back.
Sometimes this pain even goesdown, radiated in the leg, not
in the back of the sciatic nervebut in the front or in the
inside of the thigh, and that iswhat we call outlet obstipation

(26:32):
syndrome and it will induce thesame pain like in endometriosis
, but not just during men'sbleeding, but in some patients
every day, depending from food,what they are eating.
So that is exactly my message.
Endometriosis is only one cause, there are other causes.

Speaker 1 (26:50):
One of the things that you and I had talked about
previously was the fact thatit's not comorbidities, they're
all one thing.
It's all one thing, and I thinkit's hard because we
compartmentalize.
We got to solve theendometriosis first, then we got
to solve this issue, and thenwe've got to solve that issue.
It's an overwhelming thing, andwe're seeing that there's a lot

(27:12):
of correlation betweenendometriosis and some of these
other conditions.

Speaker 2 (27:17):
Exactly.

Speaker 1 (27:18):
Why do you think that that is one condition, and can
you explain that just a littlebit for us?

Speaker 2 (27:24):
The problem is the way we are thinking in medicine,
because we are thinking in asmall area.
So when I'm a gynecologist, I'mdealing with the uterus, the
tubes, the vaginas, that's it.
So when a patient is coming andsaid well, mr Possova, I pain
every month during my brain,bleeding.
Okay, could be endometriosis.

(27:44):
Yeah, mr Possova, I haveanother problem.
I have to go 20 times per dayon the toilet to pee.
Oh, that is an issue with thebladder.
That is a urologist.
And the urologist will look fora cause, like I'm looking for a
cause for pathology of thegenital organ, like
endometriosis.
He will directly look for acause that may affect the

(28:05):
bladder, so an infection,interstitial cytitis or
something like that.
And if the patient said and Ihave a thirst issue, I have
irritable bowel, then you sendthe patient to a
gastroenterologist and we'll saylet's do a colonoscopy.
Your mucosa is a little bit red, you have some chronical
inflammation of the bowel.

(28:26):
And then we say, oh, thispatient is affected from
endometriosis and withcomorbidity bladder rectum.
The patient go to the urologist.
The urologist will say she'saffected from a bladder issue,
with comorbidity, endometriosisand irritability bowel.
And I say, no, the pelvicautonomic nerve system is the

(28:49):
same for the bladder, for therectum and from the genital
organ.
So it's not a comorbidity, it'sone pathology, the irritation
of the sympathetic nerve system.
And that's the reason.
More or less all patientsaffected by endometriosis,
whether it's a deependometriosis, an adenomyosis,

(29:10):
or pelvic endometriosis,peritoneum endometriosis, they
will all experience that duringmen's bleeding they have pain,
they have to go more frequentlyon the toilet to pee.
It's easy to say you have thenext blood infection, I will
give you some antibiotic.
And at the same time they willsay oh, during my men's bleeding
I have diarrhea.
Oh, let's do a coloscopy.
Maybe you have endometriosis ofthe rectum, maybe.

(29:33):
But maybe it's an irritation ofthe pelvic nerve, which are in
charge of all these organs andthen the autonomic nerve system.
We have not to consider it asyou have a pelvic, an abdominal,
a brain, a spinal cord,autonomic nerve system.
It's one autonomic nerve system.
So if you have an irritation inthe autonomic nerve system in

(29:57):
the pelvis, you will have anactivation of the autonomic
nerve system in the pelvis.
You will have an activation ofthe autonomic nervous system in
the whole body and that's thereason why you feel tired, you
are not good that day, you havea headache and all these
symptoms.
So one pathology is a pathologyof the nervous system.

Speaker 1 (30:16):
Yeah, which would explain why there's people who
have surgery they have goodendometriosis surgery, but they
have reoccurring pain orpersistent pain because they
haven't dealt with the nervoussystem or there's something else
going on with the nervoussystem.
Is that something that you findthat we ignore a lot of, and
that's why I think there's riskin reoccurring surgeries by not

(30:40):
addressing that.

Speaker 2 (30:41):
Yeah, as you know, in the past when I performed a
surgery and the patient hadstill pain after, the question
was maybe I didn't removeeverything First?
Secondly, oh, this colleaguefrom this hospital performed a
surgery.
He's not as good as I am.
For sure he was missing someendometriosis, let go of the

(31:02):
next surgery.
Or maybe I was thinking oh, thepatient is getting a lot of
hormonal treatment, maybe theinside effect of the medical
hormonal treatment and it's truethat if patients are getting a
lot of progesterone, one of themain side effects is
constipation, another one isdepression.
So it's easy to say the patientis depressive because of the

(31:25):
side effect of the hormonaltreatment.
But as a neuropelvologist I cansay maybe it's because of the
overactivity of the nervoussystem.
And you know it's veryfrustrating when you perform a
laparoscopy and especially youwill not find a lot of things,
maybe a little bit endometriosis.
You have to do your job.
You have to convince thepatient that you found

(31:47):
endometriosis, because todaypatients want to know I have
endometriosis.
So maybe you will make abeautiful picture from a little
bit endometriosis and then afterthe procedure you will say yes,
you have endometriosis.
And then after the procedureyou will say yes, you have
endometriosis.
If you're honest, you will sayI don't find a lot.
But you know, we know thatendometriosis, the intensity of

(32:09):
the pain, is not correlated tohow many endometriosis you see.
And it's true, maybe a littlebit endometriosis will induce an
explosion of the sympatheticnerve system, depending also on
the situation of your life whereyou are.
Suppose you want to getpregnant in three years.
You don't get pregnant.
You are becoming more and morefrustrated, nervous.

(32:31):
That will increase thesympathetic nerve system and a
little bit of endometriosis willincrease even more activity of
the sympathetic inner system.
But we have also to thinkanother way.
The neuropedagogist's way is tosay we did a good surgery.
Patient has still the same pain.
Maybe I made the wrongdiagnosis.

(32:52):
She has endometriosis.
But the main reason of the painmaybe is not the endometriosis.
It's maybe something different.

Speaker 1 (33:01):
Yeah, which we've talked a little bit about this
offline a little bit but thefact that there's a lot of
providers that lack thatcuriosity, that they look inside
the box but they don't lookoutside the box.
So this is a call to thoseproviders, to any provider that
is listening it's so imperativethat you look out.

(33:22):
You don't even create a box tolook out, you have a base, but
then you explore and becomecurious, which is why, when we
were talking, something that yousaid to me that stuck out and
we'll expound on this a littlebit but you said I have never
had a box.
Why?
Why have you never had a box?
Why, why have you never had abox?
And this is where we're at isexploring the neuropelviology

(33:45):
aspect of endometriosis.
Why don't we have this box?

Speaker 2 (33:52):
The answer is maybe because I'm a French guy?
No, so where I am, you know, ifI try to do my best to treat a
patient, to help a patient, andI fail.
So one possibility is simply tosay what I said I had the wrong
diagnosis.
I have to think out of the box.

(34:12):
But the reason why I reallystart to think in
neuropalveology is nerve.
It was a little bit another one.
It's not because I'm a Frenchguy.
I want to think about out ofthe box.
But when I say which kind ofmistake I was doing, I performed
a great surgery, I was veryproud of me.
I went home, said my wife, wow,today I was good, I did a good

(34:34):
surgery.
And two weeks later I sent mypatient and she said yeah, I
have difficulty to pee, I got abladder infection.
What I have to do?
Oh, you have to use a bladdercatheter.
So I start to focus my attentionon the nerve because there was
a need to do that.
And you know, in medicine thereis two ways to see.
You can see the positive, youcan see the negative and in my

(34:59):
opinion, if you want to helppatients, you have to focus your
attention not on only what ispositive.
But you have to try tounderstand why she has pain.
You have to look for problems.
And when I was looking for whyit is like that, that is the
point where I understood for 30years, 25 years, nobody is

(35:22):
dealing with the pelvic nerve.
I would suppose we havecolleagues, neurologists, that
know everything about the nerve.
No, they don't know about thepelvic nerve.
I made my medical study.
I never heard during my medicalstudy anything about the pelvic
nerve because it was difficultfor everyone.
There are so much nerves.
Nobody has really understood orhad the understanding how

(35:45):
really it worked.
And when I was thinking, ifthere is a pathology of the
nerve, we have neurosurgeons.
But neurosurgeons are doingbrain surgery, spinal cord
surgery or maybe surgery on thenerve which they can access, but
neurosurgeons are not trainedin the pelvis.
So for 25 years I was sittingwhen I'm really honest I will

(36:08):
give you a little bit moreinternal personal thoughts my
wife had a problem after vaginaldelivery.
After delivery she developedsevere neurological problems.
So we went together toneurologists, neurosurgeons,
urologists, talk, nice talk, butfinally we were sitting home

(36:30):
together without any solution.
And that's the reason why Isaid okay, it's a big black box
in medicine.
Nobody really knows what isgoing on in this pelvis
concerning the nerve, sosomebody has to open the door.
If you talk with generalsurgeons, visceral surgeons who
are doing rectum resection maybetwo, three rectum resections

(36:53):
per day, every day the nervesare a few millimeters away from
where they perform the surgery.
But most of the generalsurgeons never saw the sacral
nerve root.
So general surgeons arebecoming aware about the
parasympathetic nerve, pelvicnerves, and starting also with

(37:14):
nerve sparing technique is agood thing.
But for 25 years when surgeonscame in my world for the boral
resection I said never I will dothat because you will cut my
nerves.
So I started to look on thenerve because I understood there
is a need to do that.

Speaker 1 (37:33):
Yeah, which is why you know it's interesting.
I had talked to some doctorsgosh a while back talking about
the importance of understandingneuropelviology, understanding
why this is so important forthem to understand, and they
didn't understand why it wasimportant for them and I think
that was so frustrating as apatient to hear.

(37:55):
I don't understand why that'simportant.
Well, it's important because Icare about my nerves, I care
about what's happening in mywhole body, but I shouldn't be
the one that has moreinformation about how this all
plays out.
I can't help myself.
I'm not educated to do that,but maybe I am.
Maybe I am educated to do that.
But I think that one of thethings that was frustrating was

(38:17):
this is so important tounderstand for them Because if
you understand the basis ofnerves and the function and
nerve sparing, you could reallyhelp your patient.
It's about patient care.
It's about patient care.
It's about caring more aboutthe long lasting outcome of your
patient, not just the here andnow.
And I think it was reallyfrustrating for me to hear that

(38:39):
and I was a little discouraged.
But I think I'm also encouragedby the fact that patients can
make an impact on the providersby saying no, I demand more.
I'm not going to settle for youknow cutting my nerves Like ask
the questions Do you do nervesparing?
How do you do nerve sparing Like?

(38:59):
Those are questions now thatpatients I feel we have to be
educated on, and that's why youknow, you and I talking about
this today is so important,because I feel like we're at
this crossroads where patientsare becoming more savvy and
they're pushing providers tobecome more engaged.

Speaker 2 (39:16):
When you said it's frustrating to see that for
quite a lot of our colleaguesthey don't want to understand
neuropelviology, the problem.
I don't think that they don'twant to understand the
neuropelviology thing A lot.
I don't think that they don'twant to understand the
neuropelviology thing.
A lot of colleagues don't knowwhat it is neuropelviology.
And that is exactly what youmentioned.
Neuropelviology is not justnerve sparing, it's also

(39:40):
understanding the nerves.
And if you follow me, you sawthat this week I made on the
YouTube.
I met on an education onendometriosis and the topic was
the LUNA technique.
So the LUNA technique is asurgical procedure where we cut
what we call the sacro-uterineligament.
So you cut the nerve and thenthe patient has less pain.

(40:04):
Yes, if you cut the nerve, thepatient will have less
information going up to thebrain.
Information.
I have pain, but you rememberwhat I say.
The nerves are working in bothdirections.
So you cannot just cut thenerves that bring the
information of pain to the brain.
You will cut also nerve goingto the vagina, to the uterus.

(40:26):
And when we think about thesympathetic or the
parasympathetic nerve system,the parasympathetic nerve system
, just in terms of fertility, itis in charge of the ovulation,
it is in charge of the motion ofthe tube.
It is in charge of the motionof the uterus.

(40:48):
It is in charge of the motionof the uterus.
He's in charge of the openingof the cervix.
He's even in charge of themotility of the spermatozoid in
men.
So suppose you perform a Lunatechnique and you cut a lot of
parasympathetic nerve system.
Maybe you will have a negativeimpact on the fertility of the

(41:08):
patient because you will maybereduce the chance to get
ovulation, you will reduce themotility of the tube, maybe the
patient will develop anincreased risk for ectopic
pregnancy and maybe it willchange the mobility of the
uterus.
You know that is something weknow when we're performing

(41:31):
surgery for deep endometriosisof what we call the
sacro-uterine ligament, then youcannot spare all the nerve.
You have to remove the diseaseand we know that in patients
when we perform surgery for deependometriosis it will be more
difficult for the patient to geta vaginal delivery because of

(41:53):
the cutting of the nerve.
In a lot of these patientsafter previous deep endometrial
surgery there will develop adysfunction of the cervix and
the cervix will not get open.
And I think a lot of patientswill recognize themselves when I
said open.
And I think a lot of patientswill recognize themselves when I
said you got a surgery for deependometriosis, you got pregnant
and then you were staying two,three days in obstetric

(42:17):
department.
They tried to give you a lot ofmedication to open the cervix.
It didn't happen.
And finally you got a C-sectionbecause the cervix didn't get
open because of the cutting ofsome of the parasympathetic
nerve of the cervix.
So you see how the nerve arelinked to everything, to

(42:39):
everything.

Speaker 1 (42:41):
Yes, and this is why it's so important for people to
learn about this.
This is why not even just theprovider, but the patient to
understand because if you've hadsurgery in the past to
understand why some of thesestruggles are occurring, I think
it's so important.
I wish I would have known someof these things prior to some of
my surgeries, but hindsight is20-20 and I'm moving forward,

(43:02):
knowing this and helping others,and that's why I'm doing what
I'm doing, because of thingslike this.
The more we learn, the moreeducated we are, the better
decisions we can make, thebetter we can advance healthcare
for women, for endometriosispatients, for all those patients
who are dealing with otherchronic illnesses, to help us
navigate life that is morefulfilling and have a better

(43:24):
quality of life.
That is the whole message here,right, yeah?

Speaker 2 (43:30):
You know, I think you cannot say we need education
for the doctor and not of thepatient, or contrary, you need
education on both.
We are partners when we aredealing with your body, even
more when you're in the war, youare on anesthesia, you have to
trust us, we have to trust youas well.

(43:50):
We have to partner, to bepartner on that.
And you know when I start forfor 30 years with endometriosis,
we know as a doctor the name,but we didn't have a lot of
knowledge about endometriosiswas for 30 years a benign
disease which is painful, that'sit.
The wait until the patient willget one, two babies and then

(44:11):
you will remove the uterus, thatwas endometriosis.
So we have to educate ourselves.
But I think the key whichreally changed the story of the
endometriosis over the last 20years was the education of the
patient.
And you know that is a shame,but when I was for two, three

(44:35):
days in Bangkok, we were talkingabout deep endometriosis and
rectum resection and then wewere talking, wow, we got a
great evolution over the last 20years.
We started to perform ballresection, now we have shaving,
now we have discoid resection,now we have robotic surgery.

(44:56):
We have such an improvement.
But if you see the data out ofthe gynecological box and you go
to the field of the generalsurgeon in your country, in the
United States, you have theCollege of Surgeons I think it
was 2015,.
They performed a paper, a bigpaper, about the situation of

(45:21):
bowel resection forendometriosis in the United
States and definitively, thenumber of patients who are
getting this procedure increasein the United States.
And in this paper, in thisstudy, if you see, the main age
is 43.
And then when I'm seeing that,I said, wow, I don't understand.

(45:43):
Because endometriosis, therectum, take 10 years to develop
.
So if you are doing more andmore borrower section for deep
endometriosis, the rectum takes10 years to develop.
So if you are doing more andmore borrower section for deep
endometriosis, because we aredoing less and less early
diagnosis and that is a bigmistake on our side.
And secondly, you know I alwayslearn, or my experience is the

(46:04):
more the patient will go indirection of the postmenopause
don't be that aggressive themore the patient will go in
direction of the postmenopause,don't be that aggressive.
So usually in patients morethan 40, don't try to do
borrower section.
So if you see this study fromthe general surgeon, you see
more and more borrower sectionand the mean age is 43.

(46:30):
I think that means some patientwith 78, 48, 49 are getting a
bowel resection.
That is insane.
That is a problem.
We need education of doctor,but patient need education as
well.
If something is wrong and youhave the feeling maybe I could

(46:52):
have such kind of things and thedoctor said, oh, you have deep
endometriosis.
But you know, bowel surgery isquite dangerous.
Wait and see.
No, don't wait and see, becausesurgery is like a vaccination.
You have to remove the deependometriosis before it starts
to grow within the rectum andthat is my main message.

(47:15):
If it's deep endometriosis, asgynecologists we have not to
wait, we have to do before itwill induce further damage and
that is really a problem ingynecology.
Normally, if we are able toincrease such an awareness,
normally the number, theincidence of bowel resection

(47:37):
should have to decrease and itincreases.
So something is going wrong.

Speaker 1 (47:43):
Yeah, well, I think too teens with endometriosis are
being dismissed as it's not badenough yet or wait until you're
older.
I mean the things that I hear,and there's a lot of providers
that are scared to even touchteens with endometriosis
Obviously not the expert side ofthings, but the general GYN,
who don't typically do justendometriosis.
They're afraid to send teensfor surgery here a lot of times.

Speaker 2 (48:08):
But they probably collect to train in this surgery
or train to manageendometriosis Right.
It has not to be a question ofego, but once again we have to
be partners all together.

Speaker 1 (48:23):
Yeah, and I will tell you, as a patient, it can be
very hard to continue to try toconvince your doctors to keep
exploring.
And that's where you see thefatigue of patients, where you
see the patients are like Idon't know what else I can do,
and they're seeing, you know six, seven, eight, nine, ten

(48:45):
doctors before someone actuallysays I believe you, let's do
something about this, let'sexplore it.
We have to keep going.
As a patient, but as providers,just sitting and listening, you
can tell a lot.
You don't even have to do apelvic exam to hear their pain.

(49:05):
It's just sitting and listeningand looking.

Speaker 2 (49:09):
And looking the face like we learned today.

Speaker 1 (49:13):
Yeah, and you know it's interesting.
So I'm going to tell you thisbecause, as a patient, this is
what we've talked about A lot oftimes when I go to see a doctor
to be believed, I won't wearmakeup, I will look a lot more
rough, I won't put myselftogether, because then I feel
like they will believe me morethan if I'm put together, and

(49:34):
that's a sad statement.

Speaker 2 (49:36):
But you know, I think it's not just a question of
belief, it's also a problem withthe medical system.
So I don't know how it is in theUnited States, but if you're in
Switzerland you will be paid bythe insurance for consultation
from 15 minutes, no more, and todeal with patients with
endometriosis sometimes it takesone hour.

(49:57):
But as a doctor, if you aredoing your job and suppose you
are an expert in endometriosisand you see every day really big
cases of endometriosis, at theend of the month you will be a
poor doctor.
Because if you see only five,six patients per day and not
what the insurance expect fromyou maybe 20, 30 patients per

(50:18):
day so that is really a problem.
The doctor who will perform agood job you know what I mean is
not fair and that's the reasonwhy I like very much the system,
for example, like in Denmark,where you have really center of
endometriosis and then they'redealing just with endometriosis.
He's calling it, and I thinkthat is a good idea.

(50:40):
I don't think that everybodyhas to be an expert in
endometriosis or an expert inneuropelviology, but at least in
diagnosis, or an expert inneuropelviology, but at least in
diagnosis.

Speaker 1 (50:50):
Right, and at least a basic understanding, I think,
is helpful.
Right, understanding theanatomy is helpful.
Understanding the role thatnerves play in our body.
I'm going to shift gears alittle bit, because this is why
I think understanding the nervesis so important.
We've talked about the rolethey play for endometriosis, but
you're exploring something moreand this is why I want to just

(51:13):
drive home a little bit more howimportant nerves are to our
body, because you're putting theconnection between nerves and
the spinal cord.
Can you explain why this is soimportant, why the research and
how you're coming about this?
Because I think it will help alot of us understand the role
that nerves play beyondendometriosis.

Speaker 2 (51:36):
So if you want to explain to me a little bit more
the neuropalveology beyond thegynecology, yes, in
neuropalveology we are dealingwith tumor of the nerve, we are
dealing with entrapment of thenerve and there is one condition
you mentioned.
It is spinal cord injury.
Spinal cord people.

(52:02):
You have the damage at thelevel of the spinal cord but the
nerves which control the legsin the lower part of the spinal
cord, so these nerves are notcontrolled anymore by the brain,
but they are still working.
And that's the reason why a lotof paraplegic or tetraplegic
patients have what we callspasticity.
Spasticity, that means thenerves below the spinal cord
lesion is still working, but notthe proper way.

(52:24):
They are not getting the rightinformation.
And that's the reason why, inthe field of neuropalveology, I
developed what we call the LIONprocedure.
Lion procedure is a technique,how to bring stimulation
electrode to the pelvic nerve,so the pelvic nerve for the
bladder, for the genital organ,for the legs, so for the

(52:45):
capability of staying up andwalking.
And that is one of my work as aneuropalveologist.
I'm doing surgery in mendespite I'm a gynecologist
because most of the spinal cordinjury people are men due to
traffic accident and I bring inelectrodes to the nerve to
recover a capability of stayingup and to work with crutches.

(53:06):
We have now more or less 150patients.
We perform surgery and 70persons are able to walk at
least 10 meters, the best oneeven 2.5 kilometers.
So you see that that isneuropalveology and that is the
reason a lot of gynecologiststhink neuropalveology is not

(53:28):
just nerve sparing.
No, no, no, that is just thesmall door we open for 30 years,
for 20 years.
Neuropalveology is much morethan that.
It's the treatment of childrenwith penibifida.
It's the treatment of childrenwith peniphyda.
It's the treatment of peoplewith multiple sclerosis, with
polyneuropathy, all thepathology of the pelvic nerves.

(53:49):
And of course we have todiscover a lot because we are
not at the end station.
I think the knowledge we haveabout the functionality of the
pelvic nerve today will probablychange a lot in 10 years, but
for that we have to look onthese nerves.

Speaker 1 (54:09):
It'll change because of people like you who are
willing to explore it, and Ithink there's doctors coming to
your courses and learning moreabout it, and these are the
changing faces ofneuropelviology.
They're going to be the changein neuropelviology, but not just

(54:31):
neuropelviology, I think,across the board for medicine.
I think these are the verycurious doctors who are going to
push boundaries and push backon the systems that have kind of
put them in a box, and I'mreally excited to see that.

Speaker 2 (54:47):
These doctors are like my metastasis.
You know If you will talk,they're in oncology, they are
metastasis and our work tellsthem.
You know, when you have apatient affected by a cancer,
usually not the primary cancerwill kill the patient, but the
metastasis, and that is exactlythe point.
I don't think that I will seeneuropelviology becoming really

(55:08):
a university sociality, but itwill, my metastasis.
They will do that, they willachieve that.
They will see that theneuropelviology will be behind
gynecology urology, anotherrecognized specialty in the
pelvis surgery.

Speaker 1 (55:25):
Yeah, it's exciting to see.
I was just at the endometriosissummit and met a lot of these
doctors and they are fantasticand they only speak of the
utmost respect for you and thework that you're doing.
But it's so interesting to seethe things that they are
exploring and looking at andchallenging each other with and

(55:47):
challenging other providers with, and talking to the patients
and educating the patients andthey are a class all their own
and they are fantastic and justgreat humans.
They're not just greatproviders, they're great humans
Some of the best.
And they have humans.
They're not just greatproviders, they are great humans
, some of the best.

Speaker 2 (56:02):
And they have time.
They have time and you know,when you're 30 and you discover
such a world like neuropulmonarybiology, it's fantastic.
You open the door from amystery.
It's wonderful when I see someof my young fellow from Sao
Paulo or from Mumbai.
These young doctors, they are30, 35, something like that.

(56:25):
That means they have still 30years to explore the mystery of
the neuropelvary.
It's fantastic.
I'm a little bit jealous.
I open the door.
They will go inside, but that'sthe way how it works.

Speaker 1 (56:41):
Yeah, and that's how it should work right.
That's how we should continuepaving the way for future
generations, and they have to bebetter than I was.

Speaker 2 (56:46):
That is the point.
A fellow has to become betterthan the master.
It is like that.
Otherwise I would do somethingwrong.

Speaker 1 (56:55):
I love that.
I love that you see it that way, that it's not about the ego,
it's about the continuing ofthat education, and that's
what's going to change.

Speaker 2 (57:04):
Yeah, but that is clear.
Otherwise the day I will die orget retired, neuropathology
will disappear with me.
No, I don't want that.
The young guy.
They will have to promote theneuropathology in the rest of
the world, and really with Aizenand the neuropathology in the
rest of the world and reallywith Eisen Eisen is the internal
society of neuropathology.
Really we are succeeding veryslowly, quite more or less in

(57:28):
the shadow.
We are not going on the streetand making a lot of noise, but
now we have more and morecolleagues in South America, a
few colleagues in the UnitedStates in South America, a few
colleagues in the United States.
Now we are becoming more andmore in India, in Asia, in
Middle East, so everywhere youhave small young guys who start

(57:50):
to let grow the neuropathologyin their own country and that is
beautiful.
It's amazing to see that.

Speaker 1 (57:57):
Yeah, you know, talking to Dr Ming is always
like one of my favorite thingsto do.
He's one of my favorite humansto talk to because I learn from
five minutes of sitting downwith him, every single time, his
wisdom and his humility behindit.
It just every single time oneof the best guys out there in my
opinion, and it's always fun tojust sit and hang out with them

(58:19):
, which I get the privilege ofdoing when we're at the summit.
So it's true, they're greatpeople and curious and I love
that.
They look circumspect.
They don't look straight aheadin this narrow box.
Very circumspect, they'realways looking around.
They're looking at seeingcorrelations, they're looking at

(58:40):
different ways of addressingnot only the disease but
diseases that like to accompanyendometriosis.
It's fascinating every singletime and I love it.

Speaker 2 (58:50):
That is a beauty of the life to have an open mind in
all direction of the life, notjust in medicine.
You have to be curious in life.
I remember a very nice wordfrom Einstein.
Einstein said innovation, orvision, is much more important
than knowledge.
And now a vision is born fromcuriosity.

Speaker 1 (59:15):
Yes, I love that and I think that is like my life
motto to always be curious aboutwhat's next and what I can
learn more from Looking forwardand exploring curiosity.
What are you excited for thatis making you more curious?

Speaker 2 (59:35):
You know, when I was a young boy I was reading Jules
Verne and Jules Verne.
When I was a young boy I wasreading Jules Verne and Jules
Verne.
He sent the people on the moon.
So it was a curiosity of thattime.
Today it's reality.
For me, my curiosity is what Icall in-body stimulation.

(01:00:06):
Future we'll try to, to treat,so to avoid disease and maybe
even to treat a lot of diseaseby using neuromodulation of the
autoimmune system.
And that is exactly the point.
You know, I mentioned you uh toto have stimulation here of the
nervous vagus in heart.
I told you, 10 minutes in themorning, 10 minutes in the
evening, but maybe it would benice to have a stimulation
within the body that make youhappy all the day, every day,

(01:00:30):
all the time.
I'm quite sure that in thefuture, in maybe 10 years, 20
years, we will have electronicin the body.
You know, 10 years, 20 years wewill have electronics in the
body.
You know, for 20, 30 years,when I was a young boy it was a
3 million guy.
You know, it was in an Americanmovie where guys got some

(01:00:52):
electronics in the body.
He was able to run more faster,he was able to do everything
much better than with a normalbody and I think really we will
go in this direction.
I don't think even I'm surewe'll go in this direction
because last year we had acongress of the AISON in Paris
and we invited a guy, anengineer, dealing with such kind

(01:01:16):
of a device which we can bringinside the body and he said we
have already all these devices.
It's just a question when we'llget an etichomite and to start
to bring such kind of device inthe body.
So suppose I have theopportunity to have a continuous
stimulation of the vagus nervesomewhere in your body.

(01:01:38):
The vagus nerve is in theabdominal cavity.
That would be easy to bring adevice there and to stimulate.
I will make you happy, you willhave less problem, you will
maybe get much easier pregnant,you will have less pain during
men bleeding.
So I think it will go in thisdirection.
And you know, I think theneuromodulation will have also

(01:02:00):
an impact in endometriosis.
Because when you haveendometriosis, endometriosis and
use a lot of adhesion in thepelvis, because endometriosis is
an inflammatory disease withinthe pelvis and there is
something what we call TNFfactor, tumor necrosis factor.
They are factors which belongto the inflammation disease

(01:02:24):
within the pelvis and there isclear evidence that with
stimulation of the vagus nervewe have an anti-TNF factor
action, so we can decreaseinflammation within the pelvis
by using the vagus nervestimulation.
And from the medical aspect,actually there are some

(01:02:47):
medication pills which will comeon the market to decrease the
level of the TNF, of the tumornecrosis factor.
My thought would be why not todo that with neuromodulation,
which will have much less sideeffect, Right and maybe in the

(01:03:07):
future?
And that's the reason why itwould be nice.
I think with stimulation of thetransauricular stimulation I
don't say that we would be maybeable to treat endometriosis and
maybe to avoid surgery, butmaybe decrease the level of pain
.
And that is also somethingBecause when you take a hormonal

(01:03:28):
treatment or painkiller youhave no impact on the activity
of the endometriosis.
You decrease the pain level.

Speaker 1 (01:03:36):
Yes, decrease that fight or flight Exactly, and
maybe we can decrease not onlythe pain but the amount of
endometriosis that invades thebody.

Speaker 2 (01:03:49):
Absolutely, absolutely.
But because there is clearlyscientific evidence that by
stimulation of the vagus nerveyou will increase the immunity,
the immune system, andendometriosis may be a kind of
immune dysregulation.
White cells from the uterus getthe capability to grow within

(01:04:12):
the abdominal cavity, on theperitoneum or somewhere, maybe
because locally there is adepression of the immune system
that allows the cells to developand to grow at that location.
Maybe with an increasing of theactivity of the parasympathetic
nerve system we will decreasethe ability of this nerve to

(01:04:34):
grow to implant within theabdominal cavities.
So why not?
Why not?
That's the future, absolutely.

Speaker 1 (01:04:42):
Well, and it's, I mean, gosh you think about.
Even you know you mentionedthis earlier and I'm kind of
backpedaling a little bit, butyou mentioned, like the
pregnancy is murder when we'rein such, you know, high fight or
flight.
That's why you know it'sinteresting that I see a bunch
of people who, during theiradoption process or during, you
know, wanting to, maybe they'regoing to have surgery for a

(01:05:05):
hysterectomy and so they've kindof relaxed and all of a sudden
they're pregnant you know, and Ithink that's only like that's
not happened for everyone and Idon't want to put that across
the board, but what I'm sayingis there's something to
down-regulating that sympatheticsystem and up-regulating that
parasympathetic system of restand digest, taking a breath, and

(01:05:29):
that's what you know.
We talk about the breath work,we talk about the stimulation,
and this all plays a part in howwe manage this disease, and I
think a lot of people are alwayscurious as to how can I help
manage my endometriosis, how canI help manage my pain.
This is an avenue whicheveryone can explore.

Speaker 2 (01:05:48):
It's not just surgical.

Speaker 1 (01:05:49):
It's a practical way for us to be able to manage pain
, to manage potential increasein the endometriosis within our
body.
You know the stimulation, thebreath, work, the food, the
stress all of these things playa part in that so effect.

Speaker 2 (01:06:08):
You know there is a simple thing when is the best
time in life of a woman to getpregnant?
In the past, always, everybodysaid the best way is to get
married and to go on honeymoon.
Why honeymoon?
Because you have anoveractivity of the
parasympathetic nerve system.
Your body is full ofbutterflies, you are happy,

(01:06:30):
happy and happy.
That increases theparasympathetic nerve system.
And in the Pons old lady alwayssays the best way to get
pregnant is to go on honeymoon.
Try to get pregnant is to go onhoneymoon.
Try to get pregnant in holidays.
Yeah, because you have noactivity of the past path
sympathetic nervous system.
So science is coming to realitywhat people in the plants were

(01:06:52):
talking.
So it's not out of the blue.
It was experience to see.
When you're happy you'regetting much easier pregnant
than when you're unhappy.

Speaker 1 (01:07:03):
And exactly.

Speaker 2 (01:07:03):
to change these things is not like to take a
normal adrenaline, take a pillor a surgery.
Everybody can try that withoutside effects.
Stimulation of the vagus nerveis an easy thing.
You found that everywhere onthe internet.
It's easy easy thing.

Speaker 1 (01:07:22):
You found that everywhere on the internet.
It's easy yeah, it is, and wehave to make time for it, and
that is one of the things that Ifeel like.
A lot of us are constantlytrying to find solutions, trying
to find ways to cope and manage.
Sometimes it's being quiet orstimulating in other ways, and I
have found myself to strugglewith this a lot because I'm a
busy body, but my busy body getsme in trouble because then it

(01:07:46):
puts me out for a couple of days.
So I think it's important aftertime, learning about this
that's something that I havereally taken to heart is how do
I do this practically in my life?
Because we talk aboutendometriosis being a whole body
disease and a whole lifedisease.
It truly is.
You can help your whole bodyand you will help the whole

(01:08:06):
disease.

Speaker 2 (01:08:07):
Yeah, and don't say that by stimulating the
parasympathetic nerve maybe youwill treat your endometriosis,
but maybe you will make yourlife a little bit easier and the
life of your family as well.

Speaker 1 (01:08:21):
Yeah.

Speaker 2 (01:08:24):
Which will make it easier.

Speaker 1 (01:08:26):
Yeah, I love that.
I love that this is a practicaltool Like.
You're not just a surgeon,you're more like a therapist at
this point.
You're a life coach.
That's what you are.
You're a life coach.
You're a life coach.
That's what you are.
You're a life coach.
Professor Possever, thank youso much for taking the time to
sit down with me.
I am leaving with my cup fulltoday just talking about this

(01:08:55):
and learning from you.
I'm excited to see whereneuropelviology goes.
I'm excited to see where you'reable to have your fellows go
and to teach them to branch out.
Much like a nerve if you igniteit one place, it'll spread out
in other places, and that iswhere your wisdom and passion
and knowledge go.
So I just appreciate everythingthat you're doing for so many
people, but for sitting down andtalking about this and bringing

(01:09:15):
this to light is going to makesuch a huge impact for so many.
So thank you so much for doingthat.

Speaker 2 (01:09:21):
I have to thank you for this opportunity and your
kindness, because it's not easy.
It's not easy, my first podcast, but it makes me happy If we
can do and, by the truth, thatis what we call the Hippocrates
Oak to do everything for mypatient.
I promise that and what we aredoing here is promoting
educational patient.
Patient have to know their ownbody and if they know their own

(01:09:46):
body, they will even better knowwhich doctor is the right one
to help them or not.

Speaker 1 (01:09:51):
Yes, it's so true Knowledge is power.

Speaker 2 (01:09:54):
Knowledge is power.

Speaker 1 (01:09:55):
Yeah, absolutely.
Well, until next time.
Everyone continue advocatingfor you and for others.